Reaching critical mass

While the dramatic growth in rural EHR adoption and the amount paid in Meaningful Use incentives so far this year bode well for the future of interoperability, I thought the most salient news this month came from the Health Affairs study on the challenges of health information exchange sustainability.

Participation in HIE is on the upswing, with 30 percent of hospitals and 10 percent of ambulatory practices now linked to one of 119 U.S. operational HIEs, according to the study but the future remains uncertain as 74 percent of HIEs report struggles with developing a sustainable business model. “There is a substantial risk that many current efforts to promote HIE will fail when public funds supporting these initiatives are depleted,” wrote Julie Adler-Milstein, assistant professor in the school of information and school of public health, University of Michigan, in Ann Arbor, and colleagues in the report.

In the study, researchers surveyed 172 organizations (out of 221 attempted) that exchanged clinical data between independent entities between August and November 2012 and compared the results with planning and operational efforts reported from surveys they conducted in 2009 and 2010.

Of the 172 respondents, 119 were actively exchanging clinical data, compared to 75 identified in a 2010 survey. The majority of operational efforts was not for profit and had been exchanging data actively for less than two years, according to the report.

Hospitals and ambulatory practices most commonly participated in HIEs, and they were the most likely to pay for it, the researchers found. However, HIE participation was significantly lower among payers, independent pharmacies and other groups.

The most common types of data exchanged included test results and summary care records for patients. For inpatient settings, discharge summaries were the most popular type of data exchanged and for ambulatory settings, clinical summaries were the most common type of data.

Although growth is substantial, HIE use has yet to reach critical mass, as two-thirds of hospitals and 90 percent of physician practices do not participate in HIEs. The authors recommend that policymakers place “explicit focus” on helping HIEs achieve financial sustainability, with a look at how all stakeholders who benefit from it can support them in the long term.

What are your thoughts on HIE and the associated interoperability achieving critical mass?

Beth Walsh

Clinical Technology + Innovation editor